By Frank Bamford; Jacqueline Y Q Mok; Donna Rosenberg, MD

The fourth variation of this significant and hugely praised consultant has been considerably revised and up to date, supplying concise, useful info on a tricky and distressing sector of paediatric drugs. This new version of the ABC of kid Protection now contains extra chapters on stomach damage, overlook and failure to thrive. It offers the newest info at the prognosis and research of abuse, and explains the present roles of social companies and the legislations in safeguarding children.

Written by means of top paediatricians, psychiatrists, social employees and attorneys, this finished publication is a useful reference for pros desirous about children’s welfare, together with common practitioners, emergency employees, paediatricians, police surgeons, psychiatrists, well-being viewers, social employees, and attorneys

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1 Despite the publicity given in the past 20 years to violence and murder of elderly women, police officers, and ethnic minorities, the person most at risk remains the infant – by parental action. Many forms of child abuse may lead to the death of the child. Physical abuse is the commonest reason. Head injuries are an important cause of death as a result of a young child being shaken, hit, or hurled. Visceral injuries, though uncommon, have a disproportionately high mortality. For all these injuries, a misleading history and delay in presentation to doctors interfere with optimal treatment.

There may be coup or contre-coup cerebral injuries. The term “shaken baby syndrome” implies knowledge of the mechanism of trauma and is best abandoned in favour of non-accidental or inflicted head injury. Perpetrators have admitted to shaking babies, either by holding them around the chest (Fig. 2) or by grabbing them by the limbs and swinging them. There is continuing debate in the literature as to whether shaking alone or shaking and impact is necessary to cause non-accidental head injury. The causative mechanism of a subdural haemorrhage is thought to involve acceleration and deceleration forces to the brain with a rotational component, causing rupture of the fine veins that cross the subdural space; these veins then bleed into that space.

Distinguishing those with potentially serious intra-abdominal injury is difficult. A careful search should be made for extra-abdominal injury, such as unexplained bruising or tenderness. Mode of injury Children are more prone than adults to intra-abdominal injury from blunt trauma. Their abdominal walls are thinner, with less interposed fat and muscle to protect the viscera. They also have more flexible ribs that cover proportionally less of the abdomen. Children have organs that are proportionally larger, predisposing them to multiple organ injury.

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